ethical issues in paramedic practice

Negligence relates to all areas of legal and ethical issues for a paramedic, if a paramedic breaches their duty of care, treats without consent, or doesn't treat patient information with the confidentiality that they deserve then they may be deemed negligent, and therefore face legal action. Children are considered vulnerable patients because until they reach the age of 16 (Mental Capacity Act 2005: section 2(5)), their parents have parental responsibility for decision-making. A complex range of personal, medical, social and environmental factors may contribute to older people being vulnerable. The paramedics should take into account the health conditions of patients, the seriousness of their problem, their relations with relatives, and probable reactions to different types of treatment before making the final decision. As such, making John secure was a priority. This essay identifies two legal and two ethical principles in paramedical science discussing how these aspects of law and ethical issues influence paramedic practice. Any consideration of beneficence is likely, therefore, to involve an examination of non-maleficence. However, in the emergency setting, where a patient is only temporarily detained (either under section 4, 5 or 136 of the MHA) and awaiting further assessment, the patient cannot yet be treated without consent under the MHA. Before the act is done, or the decision is made, regard must be had to whether the purpose for which it is needed can be as effectively achieved in a way that is less restrictive of the person's rights and freedom of action. http://dx.doi.org/10.1136/pmj.79.929.151 . Undergraduate students who study ethics in nursing have an opportunity during their clinical practice, to discuss and reflect on a range of ethical and moral actions. The question of justice is another part of the paramedical performance. Ethics and law for the paramedic Reflective practice and communication Professional issues, including clinical audit and governance and anti-discriminatory practice Psychological perspectives on health and ill health Safeguarding children Sociological perspective on health and ill health and social policy While the second article in this series (Carver et al, 2020) discussed mental illness where it related to end-of-life care and self-harm, it should be remembered that patient vulnerability can exist in those with chronic mental illness over their lifetime. Emergency Medical Services (EMS) providers face many ethical issues while providing prehospital care to children and adults. In other words, paramedics need to adopt the principle of confidentiality and credence. They must also deliver care that is consistent with ethical standards and respectful of the expectations, preferences and beliefs of the patient. Summary. John's speech was also disordered; he regularly halted sentences mid-flow and appeared confused, completely losing fluidity and continuity of his passages. Avulnerable adult is a person who is at increased risk of harm or exploitation because their ability to make decisions, express concerns or defend themselves is diminished (Oxford University Hospitals NHS Foundation Trust, 2016; Byju et al, 2019; de Chesnay, 2019; University Hospital Southampton NHS Foundation Trust, 2019). In such circumstances, clinicians have the added consideration of not only treating the patient but also ensuring the other vulnerable party is protected. Older people, persons with disabilities or mental illness, or even those who have poorer social and economic standing (such as people who are homeless) may experience periods of substantial vulnerability. Psychiatric admission for assessment and subsequent treatment if required. Samantha May However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? The first concern for an EMT must be: A. patient safety. Once an allegation is made, the HPC will arrange for it to be reviewed by paramedics, other allied health professionals, and, most importantly, members of the public, to determine if A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity to consent until proved otherwise. Monday, January 2, 2017. Putting in place a safety net for all parties is thus an important component of the paramedics' ethical practice. It seems paramount that whichever decision is made and Act is used, should the patient receive any form of involuntary treatment, the principles of the MCA and the MHA are upheld, and any decision made is in the patients best interest (Department of Health, 2005). John had arrived at a friend's house during the night, behaving in a strange, confused manner. Some of these are easier to address in the pre-hospital environment than others, for example, a simple blood glucose and temperature check excluded hypoglycaemia and lowered the index of suspicion for infection, as John had a normal temperature and blood sugar level. Decision-making is central to the everyday practice of paramedicine. Therefore, where appropriate, the MHA is likely to take precedence over the MCA where a patient is being treated for a mental health disorder. This article explores practical issues of capacity, autonomy and beneficence as they apply to some of the most common vulnerable groups that UK paramedics may encounter: children, older people, those with a mental illness and persons with a disability. This may be necessary to protect a person from harm or to prevent a deterioration in their condition (Department of Health, 2005). For paramedics, this requires careful thought on how transport and referral dispositions may affect the care and wellbeing of the other vulnerable person. As a result, it is possible to observe a contradiction between the notion of personal autonomy and medical intervention. 3 The ethical and legal frameworks within paramedic practice, and relevant to legislation. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. While the ethical tenets apply to the moral aspect of practices, the legal ones help legally arrange them. Harris and Millman (2011) highlight the importance of ruling out a physical cause for the patient presenting with altered mental status such as hypoglycaemia, head injuries, infection and alcohol or drug use. After answering the questions, use the detailed answer explanations to learn why an answer was correct or incorrect. Children are individuals so, although they have not reached adulthood, they should not be excluded from participating in healthcare decisions that affect them. Paramedics must deliver appropriate clinical care within the boundaries of the law, clinical guidelines and evidence-based standards. Another important aspect when treating patients with mental illness is the stigma associated with mental ill health (Fink and Tasman, 1992). However, what should paramedics do when their intended, evidence based course of treatment is different from the patients own wishes? For many, staying at home is an important consideration in their decisions; older people may only wish to receive care that can be delivered in their home. prevent the safe and effective practice.5 Ideally, the paramedic concerned should report any of the above issues themselves, as this reflects professional behaviour. Adult patients are presumed to have capacity to make medical decisions so treating them against their will violates their autonomy. This means that not only must they avoid doing harm - non-maleficence, they must also display active well-doing and an unselfish concern of the well being of others - beneficence. C. Follow to your local protocols and contact medical direction if unsure how to proceed. A person must be presumed to have capacity unless it is established that he lacks capacity. However, the House of Lords found there were circumstances when a child could consent to their own medical treatment without the clinician seeking or obtaining parental consent. Purpose and effectiveness - Decisions about care and treatment should be appropriate to the patient, with clear therapeutic aims, promote recovery and should be performed to current national guidelines and/or current, available best practice guidelines. There are many ethical issues that are encountered during the prehospital care of children and adults. As the paramedic role evolves, there is an opportunity to embed person-centred care in practice and to ensure that education equips paramedics . In particular, privacy and confidentiality considerations must be foremost when others are present such as work colleagues or neighbours. Police may remove a person from a public place where they are believed to be suffering from mental illness and at risk of harm to themselves or others. Their vulnerability may impede their autonomy, which can then affect their ability to self-advocate. Therefore, consideration of these effects is part of how they treat patients and make decisions. Health care professionals may be more likely to use the MCA to enforce treatment should they consider the patient unlikely to meet the threshold for detention under the MHA. It means that all actions and decisions implemented by the paramedicine practitioners should not only comply with the moral aspect but also with the legislative laws and rules (Aehlert, 2012). EBOOK: Blaber's Foundations for Paramedic Practice: A Theoretical Perspective Amanda Blaber 2018-11-19 This bestselling undergraduate level book is an ideal resource for student paramedics looking for an excellent introduction to the main theoretical subjects studied in paramedic courses, and links practice issues to the all-important theory . Integrated health care including mental health. Clinicians have an important role in supporting vulnerable patients and upholding their autonomy. Decision making in this environment is intended to provide care and treatment in the best interests of the patient. Current Issues in Paramedic Practice Also, the ambulance crew is often vulnerable to physical and verbal abuse in the course of discharging their duty. N2 - Decision-making is central to the everyday practice of paramedicine. Currently, few published research or evidence-based texts exist, specifically in relation to prehospital care. Abstract. Box 1.Autonomy in a childAs a local paramedic, you have come to know Terry quite well over the years. For others, their mental illness may impede them in such a way that clinicians will deem the person unable to make decisions about their own healthcare. With regard to the addition of powers under the MHA for paramedics, Berry (2014) argues that the MCA (2005) should be sufficient for paramedics to manage mental health patients and where needed deprive them of their liberties, however the act appears to be neither sufficiently understood nor utilised and requires the patient to lack capacity, which is complex to assess and often present in mental health cases. In such circumstances, clinicians should include the patient in the decision-making where possible, and be mindful of the impact of decisions on patients. Legal & Ethical issues associated with paramedic practice during COVID19. All of these actions may devaluate the positive results of treatment and harm patients health and well-being. Moreover, paramedics should respect the autonomy of patients and protect their privacy if needed. In order to begin to discuss some of these complexities, a case report will be presented to allow exploration of the challenges paramedics may face when trying to manage patients presenting with mental health conditions that require treatment but are refusing aid against advice. Paramedics are required to make these decisions within settings that are often disordered, uncontrolled and unpredictable, where all the relevant information and circumstances are not fully known. As such, John was assessed using the MCA (Department of Health, 2005) to ensure that he had the capability and right to make his own decisions. All rights reserved, Paramedic ethics, capacity and the treatment of vulnerable patients, Dominique Moritz, Phillip Ebbs, Hamish Carver, Explain why some people are considered vulnerable, Identify vulnerable patient groups that may be treated by paramedics, Discuss the relationship between autonomy and capacity in vulnerable patients, Reflect on their own practice to implement strategies that ensure vulnerable patients are protected. Very often, the patients points of view on the most suitable treatment do not correlate with the opinions of professionals. Chat. Therefore, paramedicine practitioners should take all measures to respect the privacy of patients and satisfy their demand for confidentiality. This is a condition referred to as alogia or poverty of speech and is another sign of psychosis (Turner, 2009; Harris and Millman, 2011; Kleiger and Khadivi, 2015). Allowing a 16-year-old person to make healthcare decisions yet restricting a person one month before their 16th birthday from doing the same seems arbitrary and illogical. On assessment, John didn't appear to understand the information given to him, the decision he needed to make, and he was unable to retain or comprehend treatment plans or the risks of noncompliance. This study highlights how paramedics' values and communication skills influence their interactions with people with dementia. It doesn't seem clear yet within the literature, whether the addition of extra powers under legislation is of benefit or not. It is important to remember that some dilemmas have no universally right solutions, and their consequences depend on every situation. care passports). Our researchers and research supervisors undertake their studies within a wide range of theoretical frameworks and models relating to the development of policy and practice that takes account of: lived experiences of health and social issues, health and social care use, and, service delivery by the nursing, midwifery and paramedic professions . Legal and ethical practice in care. The matter is that some spontaneous solutions or actions can negatively influence the patients and fail in the achievement of the desirable results (Beauchamp & Childress, 2008). That said, we must not forget the potential for the additional confusion seen overseas once given access to further legislative powers (Townsend and Luck, 2009). A recent topic of concern has been the extent to which paramedics and other health and care professionals are required to report instances of known or suspected child abuse or neglect (Foster, 2020). A key assumption of the Mental Capacity Act (MCA, 2005), is that a person has capacity until proved otherwise. The ethics in paramedicine has become a field of interest for many scientists and researchers. Autonomy is an important healthcare principle because it ensures a person maintains control over decisions relating to their healthcare. People with a disability may have carers who assist with decision-making and/or to protect their wishes, or who are entirely responsible for decision-making. Reflective practice is the link between theory and practice and a powerful means of using theory to inform practice thus promoting evidence based practice (Tsingos et al., 2014). After completing this module, the paramedic will be able to: If you would like to send feedback, please email [email protected]. More specifically, how should they navigate these situations in the presence of complexities such as diminished mental capacity and end-of-life care? Consequently, the crew had to consider alternative management plans for John. Despite this, there remain multiple barriers to their fully effective provision of such care. Alternatively, when a patient is deemed to lack capacity, paramedics can then act in a patient's best interests without their consent under the MCA; this can create an equally complex situation where paramedics attempt to ensure the patient receives the right care in the least restrictive manner possible (Townsend and Luck, 2009). Where decisions are taken which are contradictory to views expressed, professionals should explain the reasons for this. The principles of the Mental Capacity Act 2005 and the Mental Health Act 1983. According to Harris and Millman (2011), in the earlier stages of schizophrenia, a chronic form of psychosis, the patient is likely to behave in a bizarre manner that is out of character to them, as was true of John.